双相情感障碍不同临床分期患者脑磁共振波谱特征及其与认知功能损害的关系  

Brain magnetic resonance spectroscopy characteristics and their relationship with cognitive impairment in patients with bipolar disorder at different clinical stages

作　　者：陈香[1] 陈仁德[1] 罗明[1] Chen Xiang;Chen Rende;Luo Ming(Department of Psychiatry,the Third People's Hospital of Panzhihua,Panzhihua 617061,China)

机构地区：[1]四川省攀枝花市第三人民医院精神科,617061

出　　处：《神经疾病与精神卫生》2019年第6期556-561,共6页Journal of Neuroscience and Mental Health

基　　金：四川省卫生和计划生育委员会普及应用项目(17JP0204).

摘　　要：目的探讨双相情感障碍(BD)不同临床分期患者脑磁共振波谱特征及其与认知功能损害的关系。方法将2016年2月至2018年2月收治的120例BD患者按临床分期分为Ⅱ期(n=28)、Ⅲ期(n=47)、Ⅳ期(n=45),选取30例健康人作为对照组,均采用认知功能成套测试(MCCB)评定认知功能,BD患者采用磁共振氢质子波谱成像(1H-MRS)技术测定额叶、基底节、小脑胆碱复合物(Cho)、肌酸(Cr)、N-乙酰天门冬氨酸(NAA),计算NAA/Cr、Cho/Cr值,分析脑生化代谢与认知功能损害的关系。结果(1)除韦氏记忆量表(WMS-Ⅲ)外,不同临床分期BD患者各维度评分均较对照组低(P<0.05),随临床分期的上升,各评分降低,Ⅳ期<Ⅲ期<Ⅱ期(P<0.05);(2)不同分期BD患者额叶左侧NAA/Cr、左右侧Cho/Cr、基底节左右侧NAA/Cr、左侧Cho/Cr、小脑区左右侧NAA/Cr及Cho/Cr比较差异均无统计学意义(P>0.05),Ⅳ期组额叶左侧NAA/Cr及基底节右侧Cho/Cr低于Ⅲ期、Ⅱ期组(P<0.05),Ⅲ期低于Ⅱ期组(P<0.05);(3)额叶左侧NAA/Cr及基底节区右侧Cho/Cr与BVMT-R评分呈正相关(P<0.05)。结论BD不同分期患者均存在一定程度认知受损,伴额叶左侧NAA/Cr、基底节区右侧Cho/Cr脑生化代谢异常,且与认知功能评分呈正相关。Objective To explore brain magnetic resonance spectroscopy characteristics and their relationship with cognitive impairment in patients with bipolar disorder( BD) at different clinical stages. Methods A total of 120 patients with BD admitted to the hospital from February 2016 to February 2018 were selected and assigned into stage Ⅱ( n=28), stage Ⅲ( n=47) and stage Ⅳ( n=45) groups according to their clinical stages. Another 30 healthy individuals were selected as control group. MATRICS consensus cognitive battery (MCCB) was used for all subjects to assess their cognitive function. 1H magnetic resonance spectroscopy( 1H-MRS) was used to measure BD patients' choline complex( Cho), creatine( Cr) and N-acetylaspartate( NAA) of frontal lobe, basal ganglia and cerebellum, respectively. The NAA/Cr and Cho/Cr values were calculated, and the relationship between brain biochemical metabolism and cognitive impairment was analyzed. Results (1) With the exception of the scores of the Wechsler Memory Scale( WMS-Ⅲ), the scores of other dimensions in BD patients in any stage were lower than those in control group( P < 0.05). With the progression of clinical stages, the scores decreased[ stage Ⅳ<stage Ⅲ< stage Ⅱ( P<0.05)].( 2) Across the BD patients in different clinical stages, there were no significant differences in the NAA/Cr on the left side of frontal lobe, the Cho/Cr on the left and right sides of frontal lobe, the NAA/Cr on the left and right sides of the basal ganglia, the Cho/Cr on the left side of the basal ganglia, and the NAA/Cr and Cho/Cr on the left and right sides of the cerebellum( P>0.05). The NAA/Cr on the left side of frontal lobe and the Cho/Cr on the right side of basal ganglia in stage Ⅳ group were lower than those in stage Ⅱ group and stage Ⅲ group, with which, the indexes in stage Ⅲ group were lower than those in stage Ⅱ group( P<0.05).( 3) The NAA/Cr on the left side of frontal lobe and the Cho/Cr on the right side of basal ganglia were positively correlated with the score of Brief

关 键 词：双相情感障碍 认知功能 临床分期 胆碱复合物 肌酸 N-乙酰天门冬氨酸 

分 类 号：R749.16[医药卫生—神经病学与精神病学]